Abortion battle threatens to upend health insurance push

A battle over abortion is threatening to scuttle a possible bipartisan deal on providing billions of dollars to help laid-off workers keep their health insurance.

Republicans have expressed openness to a Democratic proposal to provide subsidies to help millions of people who are losing their jobs stay on their old employers’ health insurance plans under the Consolidated Omnibus Budget Reconciliation Act, commonly known as COBRA, according to congressional aides and others familiar with the talks.

But Republicans say the new funding needs to include the Hyde Amendment or another restriction on federal money going toward health plans that cover abortion, an idea Democrats oppose.

Congressional Republicans are also open to creating a new sign-up period to allow uninsured people to enroll for coverage on the Affordable Care Act (ACA) exchanges, despite the always-fraught politics of ObamaCare, sources say.

Including protections for health coverage in the next coronavirus response package is gaining urgency given that a staggering 30 million people have filed for unemployment in the past six weeks, many of whom will also be losing their employer-based health insurance in the middle of a pandemic.

The COBRA program allows people who lose their jobs to temporarily keep their old employers’ health insurance plans, but doing so is usually very expensive. The new proposal would provide government subsidies to help people afford their premiums, possibly even covering the entire cost.

But the battle over abortion, which has helped torpedo other deals on Capitol Hill before, is again threatening a compromise.

“The life issue is a huge holdup,” said a Senate GOP aide. “It’s not clear that we can overcome that holdup since both sides feel dug in at this point.”

Asked about the dispute, a senior Democratic aide said, “Now is no time for unrelated Republican ideological obsessions, trying to rewrite Americans’ private health insurance plans to insert their anti-women agenda in the middle of a crisis.”

Anti-abortion groups are also putting pressure on Congress. “It is definitely a priority,” said Mallory Quigley, a spokeswoman for the anti-abortion group Susan B. Anthony List.

Some lobbyists pushing for a solution said they think a compromise could eventually be worked out where funds being used to cover abortion are somehow segregated from other funds, similar to the accommodation that was made to pass the ACA in 2010.

Democrats maintain that the current Republican proposal would mean applying the Hyde Amendment to an employer health coverage tax benefit, which has not been done before.

Subsidizing COBRA benefits, while attracting support from the centers of both parties, also faces resistance at both ends of the political spectrum.

The left says it would be less expensive to simply expand Medicare to cover uninsured people and that the proposal from leading Democrats including House Education and Labor Committee Chairman Bobby Scott (Va.) to subsidize COBRA premiums does nothing for people who were already uninsured.

“Subsidizing COBRA, as they have suggested, would be both expensive and ineffective: Not only would health insurance corporations make massive profits off the plan—profits that come at the cost of the American taxpayer—but it would still leave tens of millions uninsured or underinsured,” Sen. Bernie Sanders (I-Vt.) wrote in a Politico op-ed last week.  

But Republicans are certain to oppose expanding Medicare to millions more people during the coronavirus pandemic, as Sanders proposes, making COBRA a more viable option.

For people who were already uninsured before the pandemic, Democrats have pushed for creating a special enrollment period to allow them a chance to sign up for coverage on the ACA exchanges.

Congressional Republicans are open to that idea, sources say, though it faces some challenges politically because of the ObamaCare connection and because the Trump administration declined to open such a period on its own. The administration instead favored paying directly for uninsured care for the coronavirus out of a $100 billion fund for hospitals, which could end up leading to an even larger government role in health care.

Republicans “aren’t generally going to want to be the ‘face’ of this issue [because] of the ACA connection,” said the Senate GOP aide. “Still, from [a Republican] perspective, better to have a few folks sign up for the commercial insurance system than the new uninsured fund, which looks like a mini public option.”

Powerful industry groups, including the American Hospital Association, America’s Health Insurance Plans and the U.S. Chamber of Commerce, are backing a push to create a new sign-up period as well as the COBRA subsidies.

“Our sense is people are open to new ideas,” Rick Pollack, CEO of the American Hospital Association, said on a press call last week when asked if Republicans are more open to new spending or ACA-related measures. “The politics that we’ve seen in the past may not be in play as we look at the challenge that is facing us.”

Those industry groups also all have an interest in supporting the system of employer-sponsored coverage in the face of a long-term threat from “Medicare for All.”

In addition to the objections from the left, some on the right are also raising concerns with the COBRA subsidies. Casey Mulligan, Brian Blase and Doug Badger, former economic advisers in the Trump and George W. Bush administrations, issued a statement last week calling the proposal “corporate welfare” for insurance companies. 

Boosting COBRA could provide an easy way for laid-off people to keep their coverage without having to go through the bureaucratic hurdles of applying for Medicaid or the ACA exchanges. But the proposal would also likely cost tens of billions of dollars per month, said David Anderson, a health policy expert at Duke University. 

“The advantage of COBRA is it would be seamless and automatic,” said Larry Levitt, a health policy expert at the Kaiser Family Foundation. “The disadvantage of COBRA is it could be quite expensive.”

The leading COBRA proposal is from Scott, the Education and Labor Committee chairman, as well as Reps. Steven Horsford (D-Nev.) and Debbie Dingell (D-Mich.). 

That proposal would cover 100 percent of people’s COBRA premiums, though it is possible a compromise measure would lower that percentage. Employer groups are pushing for at least 90 percent of the cost to be covered by the government.

“It’s a priority for our leadership and the committees of jurisdiction that have worked to protect people’s health care,” Horsford said in an interview. “I’m looking forward to finding bipartisan support.”